A model to explain road traffic data collection and registry in Iran: a grounded theory.

BACKGROUND: Sufficient data should be gathered and analyzed to increase awareness and attention of the community and policymakers in the field of road traffic injury (RTI) prevention. While various organizations and stakeholders are involved in road traffic crashes, there is no clear lead agency for data collection system in RTIs. Exploring stakeholders' perspective is one of the key sources for understanding this system. The purpose of this study is to identify the process of RTI data collection system based on stakeholders' experience. METHODS: This qualitative study was conducted employing grounded theory approach since September 2017 to December 2018 in Iran. Participants in this study were the authorities of the Emergency organizations, police, Ministry of Health and Medical Education, faculty members, as well as executive staff and road users who were involved in collecting and recording data (n=15). Data collection was carried out through face-to-face interviews using purposeful and theoretical sampling. Data analysis was performed based on Strauss and Corbin 2008. RESULTS: The core category was identified as "separated registration" explaining the process of collecting and recording road traffic injury data. Other variables obtained using the Strauss and Corbin Paradigm model were categorized as context, casual, intervening, strategies, and outcomes factors. The findings were classified into five groups including lack of trust in road safety promotion, process factors, management and organizational factors, failure of quality assurance, and administrative and organizational culture. CONCLUSIONS: The most important theory is "separated registration" and non-systematic registry system of road traffic injury data which is shown in a conceptual model. The findings of this study will help policymakers for better understanding the collecting and recording of RTI information.

Challenges of establishing a road traffic injury surveillance system: a qualitative study in a middle-income country.

BACKGROUND: Establishing effective road traffic injury surveillance is an important priority for low- and middle-income countries since a large proportion of fatal road traffic injuries occur in these countries. A surveillance system can coordinate the activities and compile the data gathered by all road safety organizations. This study aims to explore the challenges of establishing road traffic injury surveillance based on the stakeholders' experiences. METHODS: This is a qualitative content analysis study that was performed in 2018 in Iran. The study was conducted through interviews with 13 participants and employed purposeful sampling. Data generation was continued until concept saturation. RESULTS: Five main categories and 17 sub-categories were identified including: policy-making (legal authority, stakeholders, content policy and plan); process (collection and recording, analysis and interpretation, dissemination and feedback); resources and infrastructure (technology, staff, structure, finance); coherence and coordination (communication, dispersion, cooperation, consensus); and context (socio-cultural, political). CONCLUSIONS: By creating a clear structure for a road traffic injury surveillance system, identifying data collection systems and stakeholders in the field of road safety and injury prevention, determining a clear goal for improving road safety, and formulating policies for the dissemination of road traffic crash data among stakeholders, it will be possible to overcome the obstacles to establishing a surveillance system for road traffic injury.

Barriers to Breastfeeding in Disasters in the Context of Iran.

IntroductionNatural disasters have many effects on vulnerable groups, especially infants and children. Protecting breastfeeding in disasters is important, because artificial feeding puts a lot of risk to the child. In disasters, artificial nutrition is dangerous to children and its supplementation requires special equipment. There is little information on the nutritional status of infants after disasters in Iran.ProblemThe purpose of this study was to explore the barriers to appropriate lactation after disasters in Iran. METHOD: This was a qualitative study using a content analysis method. A total of 19 midwives with disaster-relief experiences were approached for interview. Data were collected using semi-structured interviews. Data analysis was performed using the Graneheim's approach. RESULTS: The categories of maternal factors, neonatal factors, management factors, and context-base factors were extracted from the data. CONCLUSION: The challenges of social support, mothers' self-efficacy, educated staff for disasters, and privacy for breastfeeding can be considered as important barriers to breastfeeding in disasters. Training programs, as well as health system support, can help overcome the breastfeeding barriers in disasters. MirMohamadaliIeM, Khani JazaniR, SohrabizadehS, Nikbakht NasrabadiA. Barriers to breastfeeding in disasters in the context of Iran. Prehosp Disaster Med. 2019;34(1):20-24.

Challenges of Cooperation between the Pre-hospital and In-hospital Emergency services in the handover of victims of road traffic accidents: A Qualitative Study

Objective. To take a deep look at the challenges of cooperation between the pre-hospital and in-hospital emergency services in the handover of victims of road traffic accidents. Methods. This is a qualitative study and the method used is of content analysis type. Semistructured interviews were used to collect the data. Through purposive sampling, fifteen employees from ambulance personnel and hospital emergency staff were selected and interviewed. They expressed their experiences of cooperation between these two teams in the handover of traffic accident casualties. The interviews were transcribed verbatim and content analysis method was used to explain and interpret the content of the interviews. Results. Three major categories were derived from the analysis of interviews: Shortage of infrastructureresources (Shortage of equipment, Shortage of physical space, and Shortage of manpower); Inefficient and unscientific management (Shaky accountability, Out-ofdate information based activities, Poor motivation, and Manpower low productivity); and Non-common language (Difference in understanding and empathy, and Difference in training and experience). Conclusion. The obtained results of this study suggest that the careful planning of resources, the promotion of managerial practices as well as empowerment program of the staff, healthcare managers and policymakers can take a pace forward in order to enter into a hearty coordination between these two services for the attention of victims of road traffic accidents.

Objetivo. Examinar los desafíos para la cooperación entre los servicios de emergencias prehospitalarias y hospitalarias en la entrega de víctimas de accidentes de tránsito. Métodos. Estudio cualitativo con análisis de contenido. Se utilizaron entrevistas semiestructuradas para la recopilación de los datos. Se seleccionaron y entrevistaron quince personas de los equipos de atención prehospitalaria y del servicio de emergencias de un hospital a partir del muestreo intencional. Los participantes expresaron sus experiencias de cooperación entre estos dos grupos en la entrega de víctimas de accidentes de tráfico. Las entrevistas se transcribieron textualmente y se utilizó el análisis de contenido para explicar e interpretar el contenido de las entrevistas. Resultados. Emergieron tres categorías principales: Escasez de recursos de infraestructura (equipos, espacio físico y de personal); Gestión ineficiente y no científica (responsabilidad inestable, actividades basadas en información desactualizada, motivación deficiente, y baja productividad de personal); y Lenguaje no común (diferencia en comprensión y empatía, y diferencia en capacitación y experiencia). Conclusión. Los resultados obtenidos en este estudio muestran dificultades con la planificación de los recursos y la promoción de las prácticas de gestión, así como la necesidad de un programa de empoderamiento del personal. Se deben formular políticas para poder avanzar en el mejoramiento de la coordinación de los servicios en la atención a víctimas de accidentes de tráfico.

Objetivo. Examinar os desafios para a cooperação entre os serviços de emergências pré-hospitalar e hospitalar na entrega de vítimas de acidentes de trânsito. Métodos. Estudo qualitativo com análise de conteúdo. Se utilizaram entrevistas semiestruturadas para a recopilação dos dados. Através da amostra intencional se selecionaram e entrevistaram quinze pessoas das equipes de atenção pré-hospitalar e do serviço de emergências de um hospital. Os participantes expressaram suas experiências de cooperação entre estes dois grupos na entrega de vítimas de acidentes de trânsito. As entrevistas se transcreveram textualmente e se utilizou a análise de conteúdo para explicar e interpretar o conteúdo das entrevistas. Resultados. Emergiram três categorias principais: Escassez de recursos de infraestrutura (equipamentos, espaço físico e de pessoal); Gestão ineficiente e não científica (responsabilidade instável, atividades baseadas em informação desatualizada, motivação deficiente, e baixa produtividade de pessoal); e Linguagem não comum (diferença em compreensão e empatia, e diferença em capacitação e experiência). Conclusão. Os resultados obtidos neste estudo mostram dificuldades com a planificação dos recursos e a promoção das práticas de gestão, assim como a necessidade de um programa de empoderamento do pessoal. Se devem formular políticas para poder avançar no melhoramento da coordenação dos serviços na atenção as vítimas de acidentes de trânsito.

Development and validation of the humanitarian aid workers resilience scale (HAWRS).

Background: Humanitarian aid workers experience various challenges in disasters, which affects their wellbeing. Being resilience can help volunteers to adapt to them. This study was conducted to develop and validate a resiliency questionnaire to evaluate the resilience of humanitarian aid workers in disasters. Methods: This study was conducted in 2 phases between Dec 2017 and Oct 2018. In the first phase for item generation, we used qualitative content analysis. Face-to-face semi-structured interviews with 18 humanitarian aid workers were used for data collection. In the second phase, by conducting a quantitative study, the psychometric properties of the scale including face, content and construct validities as well as internal and external reliabilities, were determined. Data analysis was performed using SPSS 19 and the significance level was set at less than 0.05. Results: Six main subjects were extracted from the first-stage data using content analysis. The final questionnaire included six factors and 31 items after validity and reliability criteria analysis. These six factors including organizational supports, individual factors, organizational planning, social support, teamwork and challenges of disaster scene included 52.19% of the variance. The internal consistency was confirmed as well (Cronbach's alpha = 0.814). Conclusion: This specific self-assessment questionnaire can be used for scoring the resilience of humanitarian aid workers in disasters. In the case of low resilience score of volunteers, managers should avoid sending them on missions and try to improve their resilience through educational programs.

Reproductive health in the recent disasters of Iran: a management perspective.

BACKGROUND: Natural disasters represent critical threats to the health, safety, and well-being of a community-including reproductive health, which has been neglected in disaster-stricken regions. The current study was undertaken to explore administrative issues related to post-disaster reproductive health systems in Iran. METHODS: A qualitative approach using in-depth unstructured interviews was applied to explore the administrative issues of reproductive health systems in the affected regions. A total of 22 participants were interviewed using the purposeful sampling method. Data were collected in three provinces: East Azerbaijan, Bushehr, and Mazandaran. Transcribed interviews were analyzed using the conventional content analysis. RESULTS: Six categories of management issues of reproductive health in disasters were extracted from data. These categories were: ignoring cultural factors, lack of planning, lack of training, insufficient data collection, ignoring male reproductive health, and lack of monitoring systems. CONCLUSION: Different challenges to reproductive health management that emerged from the research should be considered and included in reproductive health plans and policies in disaster-affected regions in Iran. Involving community in all processes of providing reproductive health services, from planning to monitoring, is highly suggested.

Religiosity, Gender, and Natural Disasters: A Qualitative Study of Disaster-Stricken Regions in Iran.

While religiosity is emerging as one of the more important subjects in disaster management, identifying gender differences in using religion as a coping method has attracted very little attention. The aim of this study was to explore the effects of religiosity on disaster-affected women and men in the setting of Iran. A field-based investigation using a qualitative approach was carried out to achieve the study's purpose. Data were collected using in-depth unstructured interviews with 25 participants who had been damaged by recent disasters. Two themes, negative and positive effects of religiosity, and five categories were extracted from the data. Women may be influenced by religion more than men, and thus, they can play key roles in strengthening the positive effects of religiosity.

Optimization of non-thermal plasma efficiency in the simultaneous elimination of benzene, toluene, ethyl-benzene, and xylene from polluted airstreams using response surface methodology.

Treatment with a non-thermal plasma (NTP) is a new and effective technology applied recently for conversion of gases for air pollution control. This research was initiated to optimize the efficient application of the NTP process in benzene, toluene, ethyl-benzene, and xylene (BTEX) removal. The effects of four variables including temperature, initial BTEX concentration, voltage, and flow rate on the BTEX elimination efficiency were investigated using response surface methodology (RSM). The constructed model was evaluated by analysis of variance (ANOVA). The model goodness-of-fit and statistical significance was assessed using determination coefficients (R 2 and R 2adj) and the F-test. The results revealed that the R 2 proportion was greater than 0.96 for BTEX removal efficiency. The statistical analysis demonstrated that the BTEX removal efficiency was significantly correlated with the temperature, BTEX concentration, voltage, and flow rate. Voltage was the most influential variable affecting the dependent variable as it exerted a significant effect (p < 0.0001) on the response variable. According to the achieved results, NTP can be applied as a progressive, cost-effective, and practical process for treatment of airstreams polluted with BTEX in conditions of low residence time and high concentrations of pollutants.

Risk Assessment of Drug Management Process in Women Surgery Department of Qaem Educational Hospital (QEH) Using HFMEA Method (2013).

Evaluation and improvement of drug management process are essential for patient safety. The present study was performed whit the aim of assessing risk of drug management process in Women Surgery Department of QEH using HFMEA method in 2013. A mixed method was used to analyze failure modes and their effects with HFMEA. To classify failure modes; nursing errors in clinical management model, for classifying factors affecting error; approved model by the UK National Health System, and for determining solutions for improvement; Theory of Inventive Problem Solving, were used. 48 failure modes were identified for 14 sub-process of five steps drug management process. The frequency of failure modes were as follow :35.3% in supplying step, 20.75% in prescription step, 10.4% in preparing step, 22.9% in distribution step and 10.35% in follow up and monitoring step. Seventeen failure modes (35.14%) were considered as non-acceptable risk (hazard score≥ 8) and were transferred to decision tree. Among 51 Influencing factors, the most common reasons for error were related to environmental factors (21.5%), and the less common reasons for error were related to patient factors (4.3%). HFMEA is a useful tool to evaluating, prioritization and analyzing failure modes in drug management process. Revision drug management process based focus-PDCA, assessing adverse drug reactions (ADR), USE patient identification bracelet, holding periodical pharmaceutical conferences to improve personnel knowledge, patient contribution in drug therapy; are performance solutions which were placed in work order.

The Relationship between Occupation and Semen Quality.

BACKGROUND: Infertility can be a major concern for couples trying to conceive, and occupational hazards may constitute a main cause of infertility in men. Studies conducted throughout the world indicate that physical and chemical hazards in the workplace can have a negative impact on male fertility. The main objective of this study was to determine the frequency of occupational categories of men who attended an infertility clinic, and to evaluate the differences in the semen quality parameters among occupational categories. MATERIALS AND METHODS: This cross-sectional study was conducted on 1164 males who were referred to the Infertility Research Center in Tehran for treatment of infertility in order to evaluate the effects of certain occupations on infertility. The participants were divided into several categories according to their occupations and evaluated by means of a questionnaire for duration of infertility, BMI, sperm count, percentage of normal sperm morphology and percentages of sperm with class A and class B motilities. Descriptive statistics, analysis of variance, and correlations were conducted using SPSS 16.0 for Windows. RESULTS: There were no statistically significant differences in the mean sperm count or sperm morphology between occupational categories. Assessment of the differences in the frequency of sperm motility classes between occupational categories revealed a significant difference only in the frequency of sperm with class B motility. The lowest mean percentages of sperm with class B motility were seen in those involved in the transportation industry, a finding in agreement with a number of other researches. CONCLUSION: Our findings revealed an association between occupation and sperm motility. Since our study population was relatively small and in many cases exposures to work hazards were brief, a larger study group must be evaluated in order to support the preliminary results of this study.

Musculoskeletal problems in Iranian hand-woven carpet industry: guidelines for workstation design.

Long hours of static work with awkward posture at traditionally designed looms can cause high prevalence of musculoskeletal disorders (MSDs) among carpet weavers. A comprehensive study was conducted in this industry with the objectives of determination of MSDs symptoms prevalence; identification of major factors associated with MSDs symptoms in carpet weaving occupation; and development of guidelines for weaving workstation design. In the present paper, this ergonomics study is presented. The study consisted of two phases. In the first phase, MSDs symptoms in nine Iranian provinces were surveyed by questionnaire among 1439 randomly selected weavers. Working posture and weaving workstations were ergonomically assessed as well. The results of this phase revealed that symptoms from the musculoskeletal system occurred in high rate among weavers with the prevalence significantly higher than that of the general Iranian population (P<0.001). It was found that the majority of ergonomics shortcomings originated from ill-designed weaving workstation. Based on the findings, some general guidelines for workstation design were presented. In the second phase, considering the general guidelines, an adjustable workstation was designed and constructed. To develop quantitative guidelines for optimizing workstation set-up, in the laboratory, nine sets of experimental conditions were tested, and working posture and weavers' perceptions were measured. The results of this lab work showed that working posture was acceptable for both the researchers and the weavers when the weaving height was adjusted 20 cm above the elbow height and a high seat with forward slope was used. By combining the results of the two phases, guidelines for weaving workstation design were presented. In this ergonomics-oriented workstation, loom is vertical. Seat, loom and weaving heights are adjustable. There is enough leg room under the loom. The seat with 10 degrees forward slope is adjusted 15 cm above the popliteal height of the weaver. Weaving height is set at 20 cm above the elbow height. It is believed that the recommended workstation improves working posture and results in reduced postural stress on weavers' bodies and, consequently, reduced prevalence of MSDs symptoms.